Join our PPGWe welcome enquiries from patients who would like to join our patient group.Join our PPG Patient participation group recruitment formName*Email address* Post code*Additional informationThis additional information will help to make sure we try to speak to a representative sample of the patients that are registered at this practice.Are you?* Male FemaleAge group*under 1617 - 2425 - 3435 - 4445 - 5455 - 6465 - 7475 - 84over 84EthnicityTo help us ensure our contact list is representative of our local community please indicate which of the following ethnic backgrounds you would most closely identify with?What is your ethnicity?*White: BritishWhite: IrishMixed: White and Black CaribbeanMixed: White and Black AfricanMixed: White and AsianAsian Indian or British IndianAsian Pakistani or British PakistaniAsian Bangladeshi or British BangladeshiBlack Caribbean or British CaribbeanBlack African or British AfricanAny other Black backgroundChineseAny other ethnic groupHow would you describe how often you come to the practice?* Regularly Occasionally Very rarelyMembership typeWe have two types of PPG Membership, please indicate which type of member you wish to join as: 1. Face-to-face member Members that attend meetings (in person when permitted, or remotely via phone/Microsoft Teams). Are invited to take part in surveys and for their views when the surgery plans to make a significant change. F2F members may also hold a role within the PPG such as Chair or Secretary. 2. Virtual member Members who do not regularly attend meeting (although are very welcome to if they wish) but are kept up to date, invited to complete surveys and for their views when the surgery plans to make a significant change.Thank youPlease note that no medical information or questions will be responded to. The information you supply us will be used lawfully, in accordance with the Data Protection Act 1998.The Data Protection Act 1998 gives you the right to know what information is held about you, and sets out rules to make sure that this information is handled properly.CommentsThis field is for validation purposes and should be left unchanged.